3473 Greenwood Ct SRESIDENT /
OWNER
Name: `3u ►qt -et t 0_,..)i,\nt.)•m� a .x,() C_ Phone: ( 15v ) . • 4?3 i • -I D..3 3
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Address / City / Zip: 6 3 2" CA - 1 - y LA) C'!+ 1 ar -k c y �� t \,te r,
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Applicant Is Owner X
TYPE OF WORK
[[ Contractor
Description of work: re rc() 1 -
Construction Cost: 1 D9 S DO Multi- Family Building: (Yes l( /No_)
CONTRACTO
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G 2 \ a � 1 Contact: Kar
Company: fir' -lC.l„ L7U °7` 11c- d- ( c 1 i'"
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Address: L- 1[00 tXCC�■ s ol'• ea1V ct, Cit 5"'i R t'-' k
State: YYl V\ Zip: J J`-) I to Phone: Cl C J ° 1 S -- - 7 4)0
License #: C 1Q (00) 0 50 Lead Certificate #: MA 1 a 5 03 i/ " I
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
Yes No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A, NEW BUILDING
has the City of Eagan issued a permit for a slinilar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor:
Sower & Water Contractor:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information, Portions of
the Information may be classified as non - public if you provide specific reasons that would permit the City to
conclude that they are trade secrets,
Aug. 1. 2012 12:36PM Sela Accounting
City of kap
3830 Pilot Knob Road
Eagan MN 65122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Date: / 1 / 1 2 - Site Address:397/ '477 6reenwo4 S Unit ft:
G- r -N
Applicant's Printed Name
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Applicant's Signature
Permit #:
No. 1661
Use BLUE or BLACK Ink
For Office Use /0 /
/�J 5 ~� 1
Permit Fee:
Dale Received:
Staff:
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454 -0002 for protection against underground utility damage. Call 98 hours
before you intend to dig to receive locales of underground utilities. www.00pherstateonecall.orq
I hereby acknowledge that this Information Is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; (hat 1 understand this Is not a permit, but only an application for a permit, and work Is not to start without a penult; that the work will be In
accordance with the approved plan In the case of work which requires a review and approval of plans -
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit Issuance.
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